University of Ottawa, Ottawa ON, Canada.
Department of Anaesthesiology, Cleveland Clinic, Cleveland, OH.
Medicine (Baltimore). 2021 Mar 26;100(12):e25151. doi: 10.1097/MD.0000000000025151.
In 2014, the American College of Cardiology/American Heart Association (ACC/AHA) released guidelines for ordering pre-operative echocardiograms in patients undergoing non-cardiac surgery. The purpose of this study is to determine if pre-operative echocardiograms ordered prior to fragility hip fracture repair are ordered according to these guidelines, change anesthetic management or affect patient outcomes. In addition, we attempted to evaluate the efficacy of the ACC/AHA guidelines.We conducted a 4-year retrospective chart review of acute fragility hip fractures at a single institution. Charts were reviewed to determine which patients met criteria for a pre-operative echocardiogram. Within this group we then compared patients who received a pre-operative echocardiogram to those who did not. Comparisons were made with regard to time to surgery, changes from standard anesthetic management, major adverse cardiac events, length of hospital stay, and 1-year mortality. We also examined which patients received postoperative echocardiograms and the incidence of adverse cardiac events in this group.Of 402 patients, 87 (22%) had ACC/AHA indications for pre-operative echocardiogram, and 42 (48%) of them received one. The indication to order a pre-operative echocardiogram in stable heart failure or valve disease patients if their last echo was greater than 1 year was only followed 23% of the time. In the pre-operative echocardiogram group, anesthetic management was adjusted more frequently (P = .025), and average time to surgery was greater (P < .001). The incidence of a major adverse cardiac event was 10% in the ACC/AHA echocardiogram indicated group and 3% in the non-indicated echocardiogram group. An equal number of echocardiograms were completed postoperatively as were completed under ACC/AHA pre-operative guidelines. Sixty-seven percent of the postoperative echocardiograms did not have ACC/AHA pre-operative indications.Our data demonstrates that pre-operative echocardiograms for "stable heart failure and valvular disease with greater than 1 year from last echocardiogram" is infrequently performed without significant adverse cardiac outcomes. Pre-operative echocardiography was associated with more anesthetic adjustments and longer time to surgery. Postoperative echocardiograms were done for cardiopulmonary complications. Studies need to examine and refine clinical parameters that would improve the selection of patients who would benefit from pre-operative echocardiograms.
2014 年，美国心脏病学会/美国心脏协会（ACC/AHA）发布了非心脏手术患者术前超声心动图检查的指南。本研究旨在确定在接受脆性髋部骨折修复术之前进行的术前超声心动图检查是否符合这些指南，是否改变麻醉管理或影响患者结局。此外，我们还试图评估 ACC/AHA 指南的疗效。我们对一家医疗机构的急性脆性髋部骨折进行了为期 4 年的回顾性图表审查。对图表进行审查，以确定符合术前超声心动图检查标准的患者。在该组中，我们比较了接受术前超声心动图检查的患者与未接受检查的患者。比较包括手术时间、标准麻醉管理的变化、主要不良心脏事件、住院时间和 1 年死亡率。我们还检查了哪些患者接受了术后超声心动图检查以及该组中不良心脏事件的发生率。在 402 名患者中，87 名（22%）有 ACC/AHA 术前超声心动图检查的指征，其中 42 名（48%）接受了检查。在稳定心力衰竭或瓣膜疾病患者中，如果他们的最后一次超声心动图检查大于 1 年，则仅在 23%的时间内有指征进行术前超声心动图检查。在接受术前超声心动图检查的患者中，麻醉管理调整更为频繁（P=0.025），手术时间也更长（P<0.001）。在 ACC/AHA 超声心动图检查有指征的患者中，主要不良心脏事件的发生率为 10%，而在无指征的超声心动图检查组中为 3%。完成的超声心动图数量在术后与根据 ACC/AHA 术前指南完成的数量相等。67%的术后超声心动图检查没有 ACC/AHA 术前指征。我们的数据表明，对于“有大于 1 年的上次超声心动图检查的稳定心力衰竭和瓣膜疾病”患者，不常进行术前超声心动图检查，且不会导致明显的不良心脏结局。术前超声心动图检查与更多的麻醉调整和更长的手术时间有关。术后超声心动图用于心肺并发症。需要进行研究并完善临床参数，以提高术前超声心动图检查对受益患者的选择。
